Seizure Disorders USMLE Step 1 Practice Question
A 32-year-old woman with generalized tonic-clonic seizures controlled on lamotrigine for 3 years presents planning pregnancy. Vital signs are normal (BP 118/76, HR 72, RR 16, Temp 37°C). Recent serum lamotrigine level is therapeutic at 12 mcg/mL. She denies breakthrough seizures and medication non-compliance. She expresses concern about teratogenic effects and requests counseling regarding medication safety in pregnancy. Which of the following is the most accurate counsel?
Answer choices
- ASwitch to valproic acid, which is the safest AED in pregnancy
- BContinue lamotrigine but increase the dose by 50% due to increased clearance in pregnancy
- CStop all antiepileptic drugs immediately to avoid teratogenicity
- DContinue current monotherapy; lamotrigine has low teratogenic potential and the risk of seizures outweighs medication riskCorrect answer
- ESwitch to phenytoin to reduce the risk of cleft palate
- FContinue lamotrigine but add folic acid supplementation at 5 mg daily to completely eliminate teratogenic risk
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